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Charge Type Setting Price  
Service Code NDC 9999701384
Hospital Charge Code 9999701384
Hospital Revenue Code 250
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.50
Rate for Payer: Aetna Government $0.50
Rate for Payer: Brighton Health Commercial $0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.80
Rate for Payer: Cigna LocalPlus Benefit Plan $0.68
Rate for Payer: EmblemHealth Commercial $0.50
Rate for Payer: Group Health Inc Commercial $0.50
Rate for Payer: Group Health Inc Medicare $0.35
Rate for Payer: Hamaspik Choice Inc Medicaid $0.50
Rate for Payer: Hamaspik Choice Inc Medicare $0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.65
Service Code APR-DRG 6503
Min. Negotiated Rate $29,363.00
Max. Negotiated Rate $74,073.58
Rate for Payer: Affinity Essential Plan 1&2 $74,073.58
Rate for Payer: Affinity Essential Plan 3&4 $74,073.58
Rate for Payer: Affinity Medicaid/CHP/HARP $32,921.59
Rate for Payer: Amida Care Medicaid $32,921.59
Rate for Payer: EmblemHealth Essential Plan 1&2 $74,073.58
Rate for Payer: EmblemHealth Essential Plan 3&4 $32,921.59
Rate for Payer: Fidelis CHP/HARP/Medicaid $32,921.59
Rate for Payer: Fidelis Qualified Health Plan $39,505.91
Rate for Payer: Hamaspik Choice Inc Medicaid $32,921.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid $32,921.59
Rate for Payer: Healthfirst Commercial $47,052.00
Rate for Payer: Healthfirst Essential Plan $74,073.58
Rate for Payer: Healthfirst QHP $29,363.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $32,921.59
Rate for Payer: SOMOS Essential $74,073.58
Rate for Payer: United Healthcare Essential Plan 1&2 $74,073.58
Rate for Payer: United Healthcare Essential Plan 3&4 $74,073.58
Rate for Payer: United Healthcare Medicaid $32,921.59
Rate for Payer: Wellcare CHP/FHP/Medicaid $32,921.59
Service Code APR-DRG 6502
Min. Negotiated Rate $20,122.00
Max. Negotiated Rate $66,917.23
Rate for Payer: Affinity Essential Plan 1&2 $66,917.23
Rate for Payer: Affinity Essential Plan 3&4 $66,917.23
Rate for Payer: Affinity Medicaid/CHP/HARP $29,740.99
Rate for Payer: Amida Care Medicaid $29,740.99
Rate for Payer: EmblemHealth Essential Plan 1&2 $66,917.23
Rate for Payer: EmblemHealth Essential Plan 3&4 $29,740.99
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,740.99
Rate for Payer: Fidelis Qualified Health Plan $35,689.19
Rate for Payer: Hamaspik Choice Inc Medicaid $29,740.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,740.99
Rate for Payer: Healthfirst Commercial $34,090.00
Rate for Payer: Healthfirst Essential Plan $66,917.23
Rate for Payer: Healthfirst QHP $20,122.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,740.99
Rate for Payer: SOMOS Essential $66,917.23
Rate for Payer: United Healthcare Essential Plan 1&2 $66,917.23
Rate for Payer: United Healthcare Essential Plan 3&4 $66,917.23
Rate for Payer: United Healthcare Medicaid $29,740.99
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,740.99
Service Code APR-DRG 6501
Min. Negotiated Rate $15,238.00
Max. Negotiated Rate $54,868.05
Rate for Payer: Affinity Essential Plan 1&2 $54,868.05
Rate for Payer: Affinity Essential Plan 3&4 $54,868.05
Rate for Payer: Affinity Medicaid/CHP/HARP $24,385.80
Rate for Payer: Amida Care Medicaid $24,385.80
Rate for Payer: EmblemHealth Essential Plan 1&2 $54,868.05
Rate for Payer: EmblemHealth Essential Plan 3&4 $24,385.80
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,385.80
Rate for Payer: Fidelis Qualified Health Plan $29,262.96
Rate for Payer: Hamaspik Choice Inc Medicaid $24,385.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,385.80
Rate for Payer: Healthfirst Commercial $24,714.00
Rate for Payer: Healthfirst Essential Plan $54,868.05
Rate for Payer: Healthfirst QHP $15,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,385.80
Rate for Payer: SOMOS Essential $54,868.05
Rate for Payer: United Healthcare Essential Plan 1&2 $54,868.05
Rate for Payer: United Healthcare Essential Plan 3&4 $54,868.05
Rate for Payer: United Healthcare Medicaid $24,385.80
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,385.80
Service Code APR-DRG 6504
Min. Negotiated Rate $58,807.98
Max. Negotiated Rate $132,317.95
Rate for Payer: Affinity Essential Plan 1&2 $132,317.95
Rate for Payer: Affinity Essential Plan 3&4 $132,317.95
Rate for Payer: Affinity Medicaid/CHP/HARP $58,807.98
Rate for Payer: Amida Care Medicaid $58,807.98
Rate for Payer: EmblemHealth Essential Plan 1&2 $132,317.95
Rate for Payer: EmblemHealth Essential Plan 3&4 $58,807.98
Rate for Payer: Fidelis CHP/HARP/Medicaid $58,807.98
Rate for Payer: Fidelis Qualified Health Plan $70,569.58
Rate for Payer: Hamaspik Choice Inc Medicaid $58,807.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $58,807.98
Rate for Payer: Healthfirst Commercial $115,696.00
Rate for Payer: Healthfirst Essential Plan $132,317.95
Rate for Payer: Healthfirst QHP $70,063.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $58,807.98
Rate for Payer: SOMOS Essential $132,317.95
Rate for Payer: United Healthcare Essential Plan 1&2 $132,317.95
Rate for Payer: United Healthcare Essential Plan 3&4 $132,317.95
Rate for Payer: United Healthcare Medicaid $58,807.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $58,807.98
Service Code EAPG 00579
Min. Negotiated Rate $168.94
Max. Negotiated Rate $232.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid $168.94
Rate for Payer: Healthfirst Commercial $232.28
Service Code NDC 0409488710
Hospital Charge Code 0409488710
Hospital Revenue Code 250
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.06
Rate for Payer: Aetna Government $0.06
Rate for Payer: Brighton Health Commercial $0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.10
Rate for Payer: Cigna LocalPlus Benefit Plan $0.08
Rate for Payer: EmblemHealth Commercial $0.06
Rate for Payer: Group Health Inc Commercial $0.06
Rate for Payer: Group Health Inc Medicare $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.06
Rate for Payer: Hamaspik Choice Inc Medicare $0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.08
Service Code NDC 0409488710
Hospital Charge Code 0409488710
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.06
Rate for Payer: Hamaspik Choice Inc Medicaid $0.06
Service Code NDC 5024290124
Hospital Charge Code 5024290124
Hospital Revenue Code 250
Rate for Payer: Hamaspik Choice Inc Medicaid $0.00
Service Code NDC 5024290124
Hospital Charge Code 5024290124
Hospital Revenue Code 250
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.00
Rate for Payer: Aetna Government $0.00
Rate for Payer: Brighton Health Commercial $0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.00
Rate for Payer: Cigna LocalPlus Benefit Plan $0.00
Rate for Payer: EmblemHealth Commercial $0.00
Rate for Payer: Group Health Inc Commercial $0.00
Rate for Payer: Group Health Inc Medicare $0.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.00
Rate for Payer: Hamaspik Choice Inc Medicare $0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.00
Service Code NDC 6332318520
Hospital Charge Code 6332318520
Hospital Revenue Code 250
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.17
Rate for Payer: Hamaspik Choice Inc Medicaid $0.17
Service Code NDC 6332318520
Hospital Charge Code 6332318520
Hospital Revenue Code 250
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.17
Rate for Payer: Aetna Government $0.17
Rate for Payer: Brighton Health Commercial $0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.28
Rate for Payer: Cigna LocalPlus Benefit Plan $0.23
Rate for Payer: EmblemHealth Commercial $0.17
Rate for Payer: Group Health Inc Commercial $0.17
Rate for Payer: Group Health Inc Medicare $0.12
Rate for Payer: Hamaspik Choice Inc Medicaid $0.17
Rate for Payer: Hamaspik Choice Inc Medicare $0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.22
Service Code NDC 6332318550
Hospital Charge Code 6332318550
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.09
Rate for Payer: Aetna Government $0.09
Rate for Payer: Brighton Health Commercial $0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.14
Rate for Payer: Cigna LocalPlus Benefit Plan $0.12
Rate for Payer: EmblemHealth Commercial $0.09
Rate for Payer: Group Health Inc Commercial $0.09
Rate for Payer: Group Health Inc Medicare $0.06
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Rate for Payer: Hamaspik Choice Inc Medicare $0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.12
Service Code NDC 6332318510
Hospital Charge Code 6332318510
Hospital Revenue Code 250
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.26
Rate for Payer: Aetna Government $0.26
Rate for Payer: Brighton Health Commercial $0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.42
Rate for Payer: Cigna LocalPlus Benefit Plan $0.36
Rate for Payer: EmblemHealth Commercial $0.26
Rate for Payer: Group Health Inc Commercial $0.26
Rate for Payer: Group Health Inc Medicare $0.18
Rate for Payer: Hamaspik Choice Inc Medicaid $0.26
Rate for Payer: Hamaspik Choice Inc Medicare $0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.34
Service Code NDC 6332318550
Hospital Charge Code 6332318550
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.09
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Service Code NDC 6425302030
Hospital Charge Code 6425302030
Hospital Revenue Code 250
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.08
Rate for Payer: Hamaspik Choice Inc Medicaid $0.08
Service Code NDC 6332318510
Hospital Charge Code 6332318510
Hospital Revenue Code 250
Min. Negotiated Rate $0.26
Max. Negotiated Rate $0.26
Rate for Payer: Hamaspik Choice Inc Medicaid $0.26
Service Code NDC 6332318509
Hospital Charge Code 6332318509
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.09
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Service Code NDC 0409488717
Hospital Charge Code 0409488717
Hospital Revenue Code 250
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.06
Rate for Payer: Aetna Government $0.06
Rate for Payer: Brighton Health Commercial $0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.10
Rate for Payer: Cigna LocalPlus Benefit Plan $0.08
Rate for Payer: EmblemHealth Commercial $0.06
Rate for Payer: Group Health Inc Commercial $0.06
Rate for Payer: Group Health Inc Medicare $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.06
Rate for Payer: Hamaspik Choice Inc Medicare $0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.08
Service Code NDC 0409488717
Hospital Charge Code 0409488717
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.06
Rate for Payer: Hamaspik Choice Inc Medicaid $0.06
Service Code NDC 0517302025
Hospital Charge Code 0517302025
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.10
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Service Code NDC 0517301025
Hospital Charge Code 0517301025
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.19
Rate for Payer: Aetna Government $0.19
Rate for Payer: Brighton Health Commercial $0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.30
Rate for Payer: Cigna LocalPlus Benefit Plan $0.25
Rate for Payer: EmblemHealth Commercial $0.19
Rate for Payer: Group Health Inc Commercial $0.19
Rate for Payer: Group Health Inc Medicare $0.13
Rate for Payer: Hamaspik Choice Inc Medicaid $0.19
Rate for Payer: Hamaspik Choice Inc Medicare $0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.24
Service Code NDC 0517301025
Hospital Charge Code 0517301025
Hospital Revenue Code 250
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.19
Rate for Payer: Hamaspik Choice Inc Medicaid $0.19
Service Code NDC 0338001304
Hospital Charge Code 0338001304
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Service Code NDC 0517301001
Hospital Charge Code 0517301001
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.19
Rate for Payer: Aetna Government $0.19
Rate for Payer: Brighton Health Commercial $0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.30
Rate for Payer: Cigna LocalPlus Benefit Plan $0.25
Rate for Payer: EmblemHealth Commercial $0.19
Rate for Payer: Group Health Inc Commercial $0.19
Rate for Payer: Group Health Inc Medicare $0.13
Rate for Payer: Hamaspik Choice Inc Medicaid $0.19
Rate for Payer: Hamaspik Choice Inc Medicare $0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.24